title: School based screening for tuberculosis infection in Norway: comparison of positive tuberculin skin test with interferon-gamma release assay.
abstract: BACKGROUND
  In Norway, screening for tuberculosis infection by tuberculin skin test (TST) has been offered for several decades to all children in 9th grade of school, prior to BCG-vaccination. The incidence of tuberculosis in Norway is low and infection with M. tuberculosis is considered rare. QuantiFERONTB Gold (QFT) is a new and specific blood test for tuberculosis infection. So far, there have been few reports of QFT used in screening of predominantly unexposed, healthy, TST-positive children, including first and second generation immigrants. In order to evaluate the current TST screening and BCG-vaccination programme we aimed to (1) measure the prevalence of QFT positivity among TST positive children identified in the school based screening, and (2) measure the association between demographic and clinical risk factors for tuberculosis infection and QFT positivity.
  
  
  METHODS
  This cross-sectional multi-centre study was conducted during the school year 2005-6 and the TST positive children were recruited from seven public hospitals covering rural and urban areas in Norway. Participation included a QFT test and a questionnaire regarding demographic and clinical risk factors for latent infection. All positive QFT results were confirmed by re-analysis of the same plasma sample. If the confirmatory test was negative the result was reported as non-conclusive and the participant was offered a new test.
  
  
  RESULTS
  Among 511 TST positive children only 9% (44) had a confirmed positive QFT result. QFT positivity was associated with larger TST induration, origin outside Western countries and known exposure to tuberculosis. Most children (79%) had TST reactions in the range of 6-14 mm; 5% of these were QFT positive. Discrepant results between the tests were common even for TST reactions above 15 mm, as only 22 % had a positive QFT.
  
  
  CONCLUSIONS
  The results support the assumption that factors other than tuberculosis infection are widely contributing to positive TST results in this group and indicate the improved specificity of QFT for latent tuberculosis. Our study suggests a very low prevalence of latent tuberculosis infection among 9th grade school children in Norway. The result will inform the discussion in Norway of the usefulness of the current TST screening and BCG-policy.
authors.affiliation: Division of Infectious Disease Control, Norwegian Institute of Public Health, 0403 Oslo, Norway. brita.winje@fhi.no
authors.forename: Brita Askeland
authors.initials: BA
authors.lastname: Winje
authors.forename: Fredrik
authors.initials: F
authors.lastname: Oftung
authors.forename: Gro Ellen
authors.initials: GE
authors.lastname: Korsvold
authors.forename: Turid
authors.initials: T
authors.lastname: Mannsåker
authors.forename: Ingvild Nesthus
authors.initials: IN
authors.lastname: Ly
authors.forename: Ingunn
authors.initials: I
authors.lastname: Harstad
authors.forename: Anne Margarita
authors.initials: AM
authors.lastname: Dyrhol-Riise
authors.forename: Einar
authors.initials: E
authors.lastname: Heldal
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003710:Demography; D005189:False Positive Reactions; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D011933:Reagent Kits, Diagnostic; D007371:Interferon-gamma